中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 41 Issue 11
Nov.  2025
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(11): 2359-2364

Therapeutic effect of different biliary drainage methods after laparoscopic common bile duct exploration in elderly patients with choledocholithiasis： An analysis based on propensity score matching

DOI: 10.12449/JCH251124

  • Department of Hepatobiliary Surgery，Affiliated Dalian Friendship Hospital of Dalian Medical University；Dalian Institute of Hepatobiliary Surgery；Dalian Clinical Research Center for Geriatric Medicine；Dalian Center of Gerontology，Dalian，Liaoning 116001，China

Research funding:

Dalian Medical Science Research Program Project in 2023 (2311017);

Scientific Research Fund Project of Dalian Friendship Hospital (FH2022026)

More Information
  • Corresponding author: DU Kaifang， dr.dukfang@foxmail.com （ORCID： 0009-0005-8613-8725）; LANG Guiling， langguiling2012@163.com （ORCID： 0009-0004-3353-4786）
  • Received Date: 2025-05-25
  • Accepted Date: 2025-07-31
  • Published Date: 2025-11-25
    Abstract
  •   Objective  To investigate the safety and feasibility of intra-biliary drainage tube placement after laparoscopic common bile duct exploration in elderly patients with choledocholithiasis， and to provide more options for surgical procedures in the clinical management of elderly patients with choledocholithiasis.  Methods  A retrospective analysis was performed for the clinical data of 52 elderly patients with choledocholithiasis who were admitted to Department of Hepatobiliary Surgery， Affiliated Dalian Friendship Hospital of Dalian Medical University， from November 2021 to October 2024. According to the biliary drainage method after surgery， the patients were divided into internal drainage group with 24 patients and T-tube drainage group with 28 patients， and there were 19 patients in each group after propensity score matching. The two groups were compared in terms of perioperative parameters and postoperative complications. The Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.  Results  Compared with the T-tube drainage group， the internal drainage group had a significantly shorter length of postoperative hospital stay and a significantly lower volume of postoperative bile loss （Z=-2.845 and -5.633， both P<0.05）， while there were no significant differences between the two groups in time of operation， intraoperative blood loss， and drainage tube indwelling time （all P>0.05）. There were no significant differences between the two groups in postoperative bile leak， stone recurrence， biliary stricture， and drainage tube-related complications， and the internal drainage group had a significantly lower total complication rate than the T-tube drainage group ［1 （5.3%） vs 7 （36.8%）， P<0.05］.  Conclusion  For elderly patients with choledocholithiasis， intra-biliary drainage tube placement after laparoscopic common bile duct exploration can shorten the length of postoperative hospital stay， reduce bile loss， and lower the incidence rate of postoperative complications， thereby helping to accelerate postoperative recovery.

     

    • FullText(HTML)
  • loading
    • References(27)
  • [1]
    ZHAN ZL, HAN HC, ZHAO DB, et al. Primary closure after laparoscopic common bile duct exploration is feasible for elderly patients: 5-Year experience at a single institution[J]. Asian J Surg, 2020, 43( 1): 110- 115. DOI: 10.1016/j.asjsur.2019.04.009.
    [2]
    SONG Y, MA Y, XIE FC, et al. Age, gender, geographic and clinical differences for gallstones in China: A nationwide study[J]. Ann Transl Med, 2022, 10( 13): 735. DOI: 10.21037/atm-21-6186.
    [3]
    ZHU JS, TU SJ, YANG ZJ, et al. Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: A systematic review and meta-analysis[J]. Surg Endosc, 2020, 34( 4): 1522- 1533. DOI: 10.1007/s00464-020-07394-x.
    [4]
    CHEN JB, WEI SD, SUN JJ, et al. Clinical comparison of laparoscopic combined with choledochoscope and open surgery in the treatment of gallbladder and common bile duct stones in the elderly[J]. Chin J Geriatr, 2019, 38( 11): 1270- 1272. DOI: 10.3760/cma.j.issn.0254-9026.2019.11.019.

    陈建斌, 魏思东, 孙建军, 等. 腹腔镜联合胆道镜与开腹手术治疗老年胆囊及胆总管结石的临床对比[J]. 中华老年医学杂志, 2019, 38( 11): 1270- 1272. DOI: 10.3760/cma.j.issn.0254-9026.2019.11.019.
    [5]
    GAO C, WANG JY. The development and challenges of geriatric surgery[J]. Chin J Geriatr, 2024, 43( 11): 1392- 1395. DOI: 10.3760/cma.j.issn.0254-9026.2024.11.003.

    高超, 王建业. 老年外科学的发展与挑战[J]. 中华老年医学杂志, 2024, 43( 11): 1392- 1395. DOI: 10.3760/cma.j.issn.0254-9026.2024.11.003.
    [6]
    LI CX, LI XM, LIANG ZQ, et al. Application of indocyanine green fluorescence navigation in laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis[J]. J Clin Hepatol, 2023, 39( 4): 885- 891. DOI: 10.3969/j.issn.1001-5256.2023.04.020.

    李昌旭, 李学民, 梁占强, 等. 吲哚菁绿荧光导航在老年急性胆囊炎患者经皮经肝胆囊穿刺引流术后腹腔镜胆囊切除术中的应用[J]. 临床肝胆病杂志, 2023, 39( 4): 885- 891. DOI: 10.3969/j.issn.1001-5256.2023.04.020.
    [7]
    ZHANG ZH, SHAO GH, LI YY, et al. Efficacy and safety of laparoscopic common bile duct exploration with primary closure and intraoperative endoscopic nasobiliary drainage for choledocholithiasis combined with cholecystolithiasis[J]. Surg Endosc, 2023, 37( 3): 1700- 1709. DOI: 10.1007/s00464-022-09601-3.
    [8]
    MA XH, CAI SB. The outcome and safety in laparoscopic common bile duct exploration with primary suture versus T-tube drainage: A meta-analysis[J]. Appl Bionics Biomech, 2023, 2023( 1): 7300519. DOI: 10.1155/2023/7300519.
    [9]
    XU YK, DONG CY, MA KX, et al. Spontaneously removed biliary stent drainage versus T-tube drainage after laparoscopic common bile duct exploration[J]. Medicine, 2016, 95( 39): e5011. DOI: 10.1097/md.0000-000000005011.
    [10]
    DONG HZ, LIU X, LUO MJ, et al. Application of an internal drainage tube in laparoscopic common bile duct exploration[J]. Med Int, 2021, 1( 4): 14. DOI: 10.3892/mi.2021.14.
    [11]
    DU KF, WANG XC, WEI L, et al. Clinical efficacy of intra-biliary drainage versus T-tube drainage following laparoscopic common bile duct exploration[J]. Chin J Hepatobiliary Surg, 2023, 29( 10): 732- 736. DOI: 10.3760/cma.j.cn113884-20230618-00172.

    杜开放, 王希春, 魏磊, 等. 腹腔镜下胆总管探查术放置内引流管与放置T管的临床疗效分析[J]. 中华肝胆外科杂志, 2023, 29( 10): 732- 736. DOI: 10.3760/cma.j.cn113884-20230618-00172.
    [12]
    WU PH, YU MW, CHUANG SC, et al. Comparison of laparoscopic common bile duct exploration plus cholecystectomy and endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy for elderly patients with common bile duct stones and gallbladder stones[J]. J Gastrointest Surg, 2024, 28( 5): 719- 724. DOI: 10.1016/j.gassur.2024.02.026.
    [13]
    SUWATTHANARAK T, CHINSWANGWATANAKUL V, METHASATE A, et al. Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence[J]. World J Gastrointest Endosc, 2024, 16( 6): 305- 317. DOI: 10.4253/wjge.v16.i6.305.
    [14]
    APREA G, CANFORA A, FERRONETTI A, et al. Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease[J]. BMC Surg, 2012, 12( Suppl 1): S5. DOI: 10.1186/1471-2482-12-S1-S5.
    [15]
    ZANG JF, YUAN Y, ZHANG C, et al. Laparoscopic management after failed endoscopic stone removal in nondilated common bile duct[J]. Int J Surg, 2016, 29: 49- 52. DOI: 10.1016/j.ijsu.2016.03.037.
    [16]
    RENDELL VR, PAULI EM. Laparoscopic common bile duct exploration[J]. JAMA Surg, 2023, 158( 7): 766. DOI: 10.1001/jamasurg.2022.8141.
    [17]
    LI ZQ, SUN JX, LI B, et al. Meta-analysis of single-stage versus two-staged management for concomitant gallstones and common bile duct stones[J]. J Min Access Surg, 2020, 16( 3): 206. DOI: 10.4103/jmas.jmas_146_18.
    [18]
    FAN LL, WANG Y, WU ML, et al. Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis[J]. BMC Geriatr, 2023, 23( 1): 486. DOI: 10.1186/s12877-023-04149-w.
    [19]
    XIE WC, YU WD, ZHANG Z, et al. Is T-tube drainage no longer needed for laparoscopic common bile duct exploration? A retrospective analysis and literature review[J]. Videosurgery Other Miniinvasive Tech, 2022: 99- 107. DOI: 10.5114/wiitm.2022.120727.
    [20]
    ZHANG TX, LYU YF, ZHENG JF. Advances in minimally invasive treatment for choledocholithiasis[J/OL]. Chin J Hepat Surg(Electronic Edition), 2023, 12( 5): 585- 588. DOI: 10.3877/cma.j.issn.2095-3232.2023.05.022.

    张天献, 吕云福, 郑进方. 胆总管结石微创治疗进展[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12( 5): 585- 588. DOI: 10.3877/cma.j.issn.2095-3232.2023.05.022.
    [21]
    LYON M, MENON S, JAIN A, et al. Use of biliary stent in laparoscopic common bile duct exploration[J]. Surg Endosc, 2015, 29( 5): 1094- 1098. DOI: 10.1007/s00464-014-3797-y.
    [22]
    LA PV, LE HT, TRAN TM, et al. Primary closure compared with T-tube drainage following laparoscopic common bile duct exploration among elderly patients with hepatolithiasis and/or choledocholithiasis: A comparative study using a propensity score matching[J]. HPB, 2025, 27( 2): 232- 239. DOI: 10.1016/j.hpb.2024.11.004.
    [23]
    TANG CN, TAI CK, HA JP, et al. Antegrade biliary stenting versus T-tube drainage after laparoscopic choledochotomy--a comparative cohort study[J]. Hepatogastroenterology, 2006, 53( 69): 330- 334.
    [24]
    RUDIMAN R, HANAFI RV, ALMAWIJAYA, et al. Complications of biliary stenting versus T-tube insertion after common bile duct exploration: A systematic review and meta-analysis[J]. PLoS One, 2023, 18( 1): e0280755. DOI: 10.1371/journal.pone.0280755.
    [25]
    CORAZZIARI E. Sphincter of Oddi dysfunction[J]. Dig Liver Dis, 2003, 35 Suppl 3: S26- S29. DOI: 10.1016/s1590-8658(03)00090-2.
    [26]
    ELSEBAEY MA, ENABA ME, ELASHRY H, et al. Forgotten biliary plastic stents: complications, management, and clinical outcomes[J]. Medicina(Kaunas), 2024, 60( 8): 1258. DOI: 10.3390/medicina60081258.
    [27]
    SHI TT, LIU ZQ, YUAN HB, et al. Application of propensity score matching in non-randomized controlled studies[J]. Chin J Health Statistics, 2021, 38( 2): 312- 314. DOI: 10.3969/j.issn.1002-3674.2021.02.040.

    施婷婷, 刘振球, 袁黄波, 等. 倾向性评分匹配法在非随机对照研究中的应用[J]. 中国卫生统计, 2021, 38( 2): 312- 314. DOI: 10.3969/j.issn.1002-3674.2021.02.040.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (4) PDF downloads(2) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return